Clinical Impact of an Enhanced Recovery Program for Lower-extremity Bypass.

Autor:	Tariq M; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA., Novak Z; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Spangler EL; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Passman MA; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Patterson MA; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Pearce BJ; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Sutzko DC; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Brokus SD; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Busby C; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Beck AW; Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA.; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Jun 01; Vol. 279 (6), pp. 1077-1081. Date of Electronic Publication: 2024 Jan 23.
DOI:	10.1097/SLA.0000000000006212
Abstrakt:	Objective: To determine the association of Enhanced Recovery Program (ERP) implementation with length of stay (LOS) and perioperative outcomes after lower-extremity bypass (LEB). Background: ERPs have been shown to decrease hospital LOS and improve perioperative outcomes, but their impact on patients undergoing vascular surgery remains unknown. Methods: Patients undergoing LEB who received or did not receive care under the ERP were included; pre-ERP (January 1, 2016-May 13, 2018) and ERP (May 14, 2018-July 31, 2022). Clinicopathologic characteristics and perioperative outcomes were analyzed. Results: Of 393 patients who underwent LEB [pre-ERP: n = 161 (41%); ERP: n = 232 (59%)], most were males (n = 254, 64.6%), White (n = 236, 60%), and government-insured (n = 265, 67.4%). Pre-ERP patients had higher Body Mass Index (28.8 ± 6.0 vs 27.4 ± 5.7, P = 0.03) and rates of diabetes (52% vs 36%, P = 0.002). ERP patients had a shorter total [6 (3-13) vs 7 (5-14) days, P = 0.01) and postoperative LOS [5 (3-8) vs 6 (4-8) days, P < 0.001]. Stratified by indication, postoperative LOS was shorter in ERP patients with claudication (3 vs 5 days, P = 0.01), rest pain (5 vs 6 days, P = 0.02), and tissue loss (6 vs 7 days, P = 0.03). ERP patients with rest pain also had a shorter total LOS (6 vs 7 days, P = 0.04) and lower 30-day readmission rates (32%-17%, P = 0.02). After ERP implementation, the average daily oral morphine equivalents decreased [median (interquartile range): 52.5 (26.6-105.0) vs 44.12 (22.2-74.4), P = 0.019], while the rates of direct discharge to home increased (83% vs 69%, P = 0.002). Conclusions: This is the largest single-center cohort study evaluating ERP in LEB, showing that ERP implementation is associated with shorter LOS and improved perioperative outcomes. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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